Provider Demographics
NPI:1699709824
Name:DIALYSIS PARTNERS 1 INC.
Entity type:Organization
Organization Name:DIALYSIS PARTNERS 1 INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:A
Authorized Official - Last Name:LARRANAGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-498-0018
Mailing Address - Street 1:220 KISSIMMEE PARK RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-1547
Mailing Address - Country:US
Mailing Address - Phone:407-498-0018
Mailing Address - Fax:
Practice Address - Street 1:220 KISSIMMEE PARK RD
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-1547
Practice Address - Country:US
Practice Address - Phone:407-498-0018
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL06155284261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
102832Medicare Oscar/Certification